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NICE clinical guideline NG39: Major trauma: assessment and initial management
  1. Anand Nitin Kanani1,
  2. Stuart Hartshorn2
  1. 1West Midlands Deanery, Birmingham, UK
  2. 2Emergency Department, Birmingham Children's Hospital, Birmingham, UK
  1. Correspondence to Dr Stuart Hartshorn, Emergency Department, Birmingham Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham B4 6NH, UK; stuart.hartshorn{at}

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Major trauma is the most frequent cause of death in the UK for children aged between 1 and 18 years. It is responsible for 31% of deaths in children aged 1–4 years, increasing to 48% of deaths in young people aged 15–18 years.1 The most common mechanism of injury is high-energy blunt trauma from road traffic collisions. This mechanism is responsible for 41% of injury deaths in children (1–9 years old) and 77% among young people (10–18 years old).2

One of the great advances in outcomes for children has been the development of paediatric major trauma centres (MTCs) within trauma networks. Prehospital teams will follow defined algorithms to divert severely injured children to MTCs. However, 25% of severely injured children will be brought by their parents in their own vehicles to non-MTC hospitals.3

Hospital trauma care for children and young people comprises a multispecialty team, including paediatricians, to rapidly identify and appropriately treat high-risk injury patterns. A major trauma outcome study demonstrated that between 1989 and 1995, good quality hospital care reduced the odds of death after severe injury by 16% per year in patients younger than 25 years.4

The National Institute for Health and Care Excellence (NICE) NG39 ‘Major trauma: assessment and initial management’ guideline was published in February 2016.5 The guideline aims to reduce deaths and disabilities in people with serious injuries by improving the quality of their immediate care. This guideline was published alongside four other major trauma-related guidelines (see box 1). In this guideline review, we focus only on those recommendations of NG39 specific to children and young people.

Box 1


  • Full National Institute for Health and Care Excellence (NICE) guideline Major trauma: assessment and initial management (NG39)


  • Additional NICE guidelines on the theme of major trauma:

    • Fractures (complex): assessment and initial management (NG37) …

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  • Twitter Follow Anand Nitin Kanani @AnandKanani, Stuart Hartshorn, @stuarthartshorn

  • Contributors ANK drafted the initial manuscript and drafted revisions. SH developed the concept for the manuscript and contributed to the revision and development of the final manuscript.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.